Patient’s name: Mary Trafford
Age: 80 years old female
Past Medical History
Medication history/ Allergies
You are Sam. A district nurse and you are calling on Behalf of Mrs. Mary Trafford. You went to visit Mary to help with wound dressing. She mentioned to you that she had a fall yesterday when moving from her Room to her bathroom to use the loo. This is the 2nd fall in the last one month. She did not sustain any Injury. It was a mechanical fall; she says she tripped and fell. She lives alone in a 2-bed duplex (Town house).
Say NO to any other questions asked.
Patient says that her confidence has been affected and she lives in fear that she will fall again. She looks frail.
Patient will like to be left at home and would not consider going to a nursing home.
You have checked her lying and standing blood pressure – lying 118/75mmHg, standing 117/72mmHg. Patient was not dizzy on standing. Pulse is 68bpm full volume and regular, HS-s1, s2 nil murmurs. No obvious gait problems or neurology.
Idea: You are not sure what is causing her fall but you suspect it may be due to her being frail.
Concern- You are concerned that she lives alone and have had 2 falls in last 1 month.
Expectation– You want the GP to suggest measures to help prevent patient from falling.
Questions for the doctor
What can you do now to prevent patient from falling again?
Seen by Dr. Emeka Agu (Clinical practitioner role) – 4 weeks ago.
History: Home visit- reason for visit: Fall at home. Patient had a fall while moving from her room to kitchen this morning and had a long lie, sustaining injury to her right elbow.
Examination– deep laceration to right elbow with some bony
tenderness. BP 130/70
Plan: Admit via Emergency department to rule out fracture of right elbow and also suturing of laceration. Ambulance organised.
Emergency department letter
Dear GP,
I am writing to inform you about the discharge of your patient, Mary Trafford, who was admitted to St Anthony’s Hospital following a mechanical fall at home.
Mary sustained a deep laceration to her right elbow after tripping while moving from her room to the kitchen. There was some bony tenderness but no fracture was identified on X-ray. The wound was sutured under local anaesthesia, and she was stable throughout her stay. No new medications were started during her admission. She has been discharged back to yourcare with district nurses arranged to follow up with wound dressing and remove the stitchesin 10 days.
Please continue to monitor her general health and consider referring her for a falls assessmentor physiotherapy if necessary.
If you require further information, feel free to contact me.
Kind regards,
Dr Koffi Anan, MBBS (Ghana), FRCEM
ED Registrar
St Anthony Hospital
District nurse (Samantha Banks) on phone to discuss issues.
History
Explain to your colleague; Sam, thank you for seeing Mrs. Trafford and providing such a thorough assessment. I agree with you that her recurrent falls are likely due to frailty, but there are also other factors that could be contributing, like her multiple medications. Specifically, medications like sertraline indapamide, amitriptyline and omeprazole can affect her sodium levels and may be increasing her risk of falls.
Would you be comfortable getting some blood tests done for her, including FBC, U+E’s, LFT, and Hba1c? I’ll make sure to raise the forms for you.
Can she arrange to get anti-fall stockings? If not, I can ask our social prescriber and see if we can arrange this for her.
Please, ensure she’s reminded to keep her home clear of any loose rugs or obstacles that might cause tripping. Also, I’ll be referring her to the falls clinic so she can be properly assessed by a physiotherapist. In addition, I’ll organize a falls alarm for her, so that if she does fall, she’ll be able to alert emergency services.
It would also be a good idea for her to get an eye check, just to make sure her vision is still okay, as this can sometimes contribute to falls.Meanwhile, I’ll get her medication reviewed by the pharmacist, and I’d advise that she stops taking the indapamide for now.
Thanks again for all your hard work with Mrs. Trafford’s care, Sam
Management